阿托伐他汀对造影剂肾病的预防作用

Effect of Atorvastatin on Preventing Contrast-Induced Nephropathy

目的观察阿托伐他汀对冠状动脉介入诊断及治疗的患者肾功能、尿微量蛋白改变的影响。方法 246例冠状动脉介入诊断与治疗的患者随机分为他汀组和对照组,每组123例。他汀组于冠状动脉造影术前3 d开始每晚顿服阿托伐他汀40 mg,对照组未服用阿托伐他汀及其他调脂类药。所有患者采用水化治疗。观察患者术前1 d、术后36～48 h血清肌酐(Scr)、超敏C反应蛋白(hsCRP)、内生肌酐清除率(Ccr)、尿α1微球蛋白(α1-MG)/尿肌酐(Ucr)、尿微量白蛋白(mALB)/尿肌酐(Ucr)的改变情况。结果两组患者术后血hsCRP、Scr,尿αl-MG/Ucr及mALB/Ucr较术前均升高(均P<0.05),而血Ccr较术前降低(P<0.05)。对照组术后血hsCRP、尿αl-MG/Ucr较他汀组术后明显升高(P<0.05),对照组造影剂肾病发生率(8.13%)高于他汀组(0.81%,P<0.05)。结论造影剂可造成轻微的肾功能损害;术前3 d使用大剂量阿托伐他汀,可能具有减轻炎症反应、预防造影剂肾病发生的作用。

Objective To study the effects of atorvastatin on contrast-induced renal function and urinary protein change in patients undergoing diagnostic and therapeutic coronary intervention.Methods Two hundred and forty-six patients who underwent coronary angiography or percutaneous coronary intervention（PCI） were randomized to receive atorvastatin（40 mg,qn,n=123） or no atorvastatin（n=123） treatment 3 days before coronary angiography.All patients received hydrated therapy.Serum creatinine（Scr）,urinary αl-microglobulin（αl-MG）,and urinary albumin（mALB） were checked for evidence of tubular or glomerular damage at start,and 36 to 48 hours after the administration of a radiocontrast agent.High-sensitive C-reactive protein（hsCRP） levels,urinary αl-MG/ urinary creatinine（Ucr） and mALB/ Ucr were also assessed at the same time.Creatinine clearance（Ccr） was calculated according to Cockcroft-Gault formulas basing on serum creatinine.Results（1） In the control group and atorvastatin-treated group,comparison with the value before coronary angiography or PCI,urinary αl-MG/ Ucr,mALB/ Ucr,Scr and hsCRP significantly increased from 36 to 48 hours after angiography or PCI（P0.05）.Ccr significantly decreased from 36 to 48 hours after angiography or PCI（P0.05）.（2） Compared the atorvastatin-treated group,the values of hsCRP,urinary αl-MG/ Ucr significantly increased at the 2nd day after angiography or PCI in the control group（P0.05）,incidence of contrast induced nephropathy（CIN）significantly increased too（8.13% vs 0.81%,P0.05）.Conclusions Contrast media induces light renal function damage.Pretreatment with atorvastatin 40 mg/qn for 3 days could significantly reduce procedural inflammatory reaction and prevent contrast-induced nephropathy.